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SAINT for Treatment of Preoperative Depression to Reduce Opioid Use Following Arthroplasty

Primary Purpose

Treatment Resistant Depression

Status
Withdrawn
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Active TBS-DLPFC
Sham TBS-DLPFC
Open label TBS-DLPFC
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Treatment Resistant Depression focused on measuring transcranial magnetic stimulation, theta burst

Eligibility Criteria

22 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male or female, 22 to 80 years of age.
  • Able to provide informed consent.
  • Diagnosed with Major Depressive Disorder (MDD) and currently experiencing a Major Depressive Episode (MDE).
  • Participants may currently be on a stable and adequate dose of SSRI antidepressant therapy. Participants may choose to not be on antidepressant therapy for the study duration, or to be switched from other classes to a medication from the SSRI class.
  • Participants may also have a history of intolerance to at least 2 antidepressant medications. These patients with the intolerance history will not be required to be currently taking an antidepressant medication.
  • Participants must qualify as "Moderately Treatment Refractory" or "High Treatment Refractory" using the Maudsley staging method.
  • Meet the threshold on the total HAMD17 score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0).
  • Meet the threshold on the total MADRS score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0).
  • Meet the threshold on the total BDI-II score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0).
  • In good general health, as ascertained by medical history.
  • If female, a status of non-childbearing potential or use of an acceptable form of birth control. The form of birth control will be documented at screening and baseline.
  • Concurrent hypnotic therapy (e.g., with zolpidem, zaleplon, melatonin, or trazodone) will be allowed if the therapy has been stable for at least 4 weeks prior to screening and if it is expected to remain stable.

Exclusion Criteria:

  • Female of childbearing potential who is not willing to use one of the specified forms of birth control during the study.
  • Female that is pregnant or breastfeeding.
  • Female with a positive pregnancy test at participation.
  • Total HAMD17 score of < 20 at the screen or baseline visits.
  • Total MADRS score of < 20 at the screen or baseline visits.
  • Total BDI-II score of < 20 at the screen or baseline visits.
  • Current diagnosis of a Substance Use Disorder (Abuse or Dependence, as defined by DSM-IV-TR), with the exception of nicotine dependence, at screening or within six months prior to screening.
  • Current diagnosis of Axis I disorders other than Dysthymic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Agoraphobia, or Specific Phobia (unless one of these is comorbid and clinically unstable, and/or the focus of the participant's treatment for the past six months or more).
  • History of schizophrenia or schizoaffective disorders, or any history of psychotic symptoms in the current or previous depressive episodes.
  • Any Axis I or Axis II Disorder, which at screening is clinically predominant to their MDD or has been predominant to their MDD at any time within six months prior to screening.
  • Considered at significant risk for suicide during the course of the study.
  • Has a clinically significant abnormality on the screening examination that might affect safety, study participation, or confound interpretation of study results.
  • Participation in any clinical trial with an investigational drug or device within the past month or concurrent to study participation.
  • Any current or past history of any physical condition which in the investigator's opinion might put the subject at risk or interfere with study results interpretation.
  • History of positive screening urine test for drugs of abuse at screening: cocaine, amphetamines, barbiturates, opiates.
  • Current (or chronic) use of opiates.
  • History of epilepsy.
  • History of rTMS exposure.
  • History of any implanted device or psychosurgery for depression.
  • History of ECT intolerance.
  • History of shrapnel or metal in the head or skull.
  • "Low Treatment Refractory" using the Maudsley staging method.
  • History of cardiovascular disease or cardiac event.
  • History of OCD.
  • History of autism spectrum disorder.
  • History of intractable migraine
  • History of independent sleep disorder.

Sites / Locations

  • Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Sham Comparator

Arm Label

Active TBS-DLPFC

Sham TBS-DLPFC

Arm Description

The active group will receive theta-burst TMS stimulation.

The sham group will receive sham theta-burst TMS stimulation. Participants will have the option of open label TBS-DLPFC treatment following study completion.

Outcomes

Primary Outcome Measures

Change in Montgomery-Γ…sberg Depression Rating Scale (MADRS) score from pre-treatment to 1-month post-treatment.
A ten item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders.

Secondary Outcome Measures

Percentage change in the Hamilton Rating Scale for Depression (HAMD-17)
A provider administered questionnaire used to assess remission and recovery from depression.
Percentage change in the Columbia Suicide Severity Rating Scale (C-SSRS)
A suicidal ideation rating scale created by researchers at Columbia University.
Percentage change in the Hamilton Rating Scale for Depression (HAM-6)
A 6 item questionnaire used to score the severity of depression.
Percentage change in the Hamilton Rating Scale for Depression (HAMD-17)
A provider administered questionnaire used to assess remission and recovery from depression.
Change in baseline functional connectivity to immediate post-treatment using functional MRI
MR imaging of the brain to measure the functional connectivity between the subcallosal cingulate to the default mode network.
Change in baseline functional connectivity to 1-month post-treatment
The investigators will assess functional connectivity as seen on resting state fMRI, between the subcallosal cingulate to the default mode network and within the default mode network.
Change in baseline heart rate variability through immediate post treatment and 1-month post treatment
Heart rate variability measures will be compared baseline, immediate post treatment and 1-month post treatment

Full Information

First Posted
October 25, 2019
Last Updated
December 12, 2022
Sponsor
Stanford University
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1. Study Identification

Unique Protocol Identification Number
NCT04195308
Brief Title
SAINT for Treatment of Preoperative Depression to Reduce Opioid Use Following Arthroplasty
Official Title
Accelerated Intermittent Theta-burst Stimulation for Treatment of Preoperative Depression to Reduce Conversion of Acute to Chronic Opioid Use Following Arthroplasty
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Withdrawn
Why Stopped
Logistical constraints
Study Start Date
June 2024 (Anticipated)
Primary Completion Date
November 2026 (Anticipated)
Study Completion Date
November 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Stanford University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study evaluates an accelerated schedule of theta-burst stimulation using a transcranial magnetic stimulation device for treatment-resistant depression. In a double-blind fashion, half the participants will receive accelerated theta-burst stimulation while half will receive sham treatment.
Detailed Description
Repetitive transcranial magnetic stimulation (rTMS) is an established technology as therapy for treatment-resistant depression. The approved method for treatment is 10Hz stimulation for 40 min over the left dorsolateral prefrontal cortex (L-DLPFC). This methodology has been effective in real world situations. The limitations of this approach include the duration of the treatment (approximately 40 minutes per treatment session, 5 days per week, for 4-8 weeks). Recently, researchers have pursued modifying the treatment parameters to reduce treatment times with some preliminary successes. This study aims to further modify the parameters to create a more rapid form of the treatment and look at the change in neuroimaging biomarkers.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Treatment Resistant Depression
Keywords
transcranial magnetic stimulation, theta burst

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Active TBS-DLPFC
Arm Type
Experimental
Arm Description
The active group will receive theta-burst TMS stimulation.
Arm Title
Sham TBS-DLPFC
Arm Type
Sham Comparator
Arm Description
The sham group will receive sham theta-burst TMS stimulation. Participants will have the option of open label TBS-DLPFC treatment following study completion.
Intervention Type
Device
Intervention Name(s)
Active TBS-DLPFC
Intervention Description
Participants in the active stimulation group will receive intermittent TBS to left DLPFC. The L-DLPFC will be targeted utilizing the Localite neuronavigation system. Stimulation intensity will be standardized at 90% of RMT and adjusted to the skull to cortical surface distance (see Nahas 2004). Stimulation will be delivered to the L-DLPFC using a MagPro stimulator.
Intervention Type
Device
Intervention Name(s)
Sham TBS-DLPFC
Intervention Description
The parameters in the active arms will be as above with the internal randomization of the device internally switching to sham in a blinded fashion.
Intervention Type
Device
Intervention Name(s)
Open label TBS-DLPFC
Intervention Description
Patients will have the option of receiving active, open label aTBS treatment following sham. Stimulation will be delivered to the L-DLPFC using a MagPro stimulator or Nexstim TMS device.
Primary Outcome Measure Information:
Title
Change in Montgomery-Γ…sberg Depression Rating Scale (MADRS) score from pre-treatment to 1-month post-treatment.
Description
A ten item diagnostic questionnaire used to measure the severity of depressive episodes in patients with mood disorders.
Time Frame
Pretreatment to 1-month posttreatment
Secondary Outcome Measure Information:
Title
Percentage change in the Hamilton Rating Scale for Depression (HAMD-17)
Description
A provider administered questionnaire used to assess remission and recovery from depression.
Time Frame
4 weeks posttreatment
Title
Percentage change in the Columbia Suicide Severity Rating Scale (C-SSRS)
Description
A suicidal ideation rating scale created by researchers at Columbia University.
Time Frame
Pretreatment, immediately posttreatment, 2 weeks posttreatment, 4 weeks posttreatment
Title
Percentage change in the Hamilton Rating Scale for Depression (HAM-6)
Description
A 6 item questionnaire used to score the severity of depression.
Time Frame
Follow-up every 2 weeks for 6 months by telephone
Title
Percentage change in the Hamilton Rating Scale for Depression (HAMD-17)
Description
A provider administered questionnaire used to assess remission and recovery from depression.
Time Frame
Pretreatment, immediately posttreatment, 2 weeks posttreatment
Title
Change in baseline functional connectivity to immediate post-treatment using functional MRI
Description
MR imaging of the brain to measure the functional connectivity between the subcallosal cingulate to the default mode network.
Time Frame
Pretreatment to immediately posttreatment
Title
Change in baseline functional connectivity to 1-month post-treatment
Description
The investigators will assess functional connectivity as seen on resting state fMRI, between the subcallosal cingulate to the default mode network and within the default mode network.
Time Frame
Pretreatment to 1-month post-treatment
Title
Change in baseline heart rate variability through immediate post treatment and 1-month post treatment
Description
Heart rate variability measures will be compared baseline, immediate post treatment and 1-month post treatment
Time Frame
Pretreatment, immediately posttreatment and 1-month post treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
22 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male or female, 22 to 80 years of age. Able to provide informed consent. Diagnosed with Major Depressive Disorder (MDD) and currently experiencing a Major Depressive Episode (MDE). Participants may currently be on a stable and adequate dose of SSRI antidepressant therapy. Participants may choose to not be on antidepressant therapy for the study duration, or to be switched from other classes to a medication from the SSRI class. Participants may also have a history of intolerance to at least 2 antidepressant medications. These patients with the intolerance history will not be required to be currently taking an antidepressant medication. Participants must qualify as "Moderately Treatment Refractory" or "High Treatment Refractory" using the Maudsley staging method. Meet the threshold on the total HAMD17 score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0). Meet the threshold on the total MADRS score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0). Meet the threshold on the total BDI-II score of >/=20 at both screening and baseline visits (Day -5/-14 and Day 0). In good general health, as ascertained by medical history. If female, a status of non-childbearing potential or use of an acceptable form of birth control. The form of birth control will be documented at screening and baseline. Concurrent hypnotic therapy (e.g., with zolpidem, zaleplon, melatonin, or trazodone) will be allowed if the therapy has been stable for at least 4 weeks prior to screening and if it is expected to remain stable. Exclusion Criteria: Female of childbearing potential who is not willing to use one of the specified forms of birth control during the study. Female that is pregnant or breastfeeding. Female with a positive pregnancy test at participation. Total HAMD17 score of < 20 at the screen or baseline visits. Total MADRS score of < 20 at the screen or baseline visits. Total BDI-II score of < 20 at the screen or baseline visits. Current diagnosis of a Substance Use Disorder (Abuse or Dependence, as defined by DSM-IV-TR), with the exception of nicotine dependence, at screening or within six months prior to screening. Current diagnosis of Axis I disorders other than Dysthymic Disorder, Generalized Anxiety Disorder, Social Anxiety Disorder, Panic Disorder, Agoraphobia, or Specific Phobia (unless one of these is comorbid and clinically unstable, and/or the focus of the participant's treatment for the past six months or more). History of schizophrenia or schizoaffective disorders, or any history of psychotic symptoms in the current or previous depressive episodes. Any Axis I or Axis II Disorder, which at screening is clinically predominant to their MDD or has been predominant to their MDD at any time within six months prior to screening. Considered at significant risk for suicide during the course of the study. Has a clinically significant abnormality on the screening examination that might affect safety, study participation, or confound interpretation of study results. Participation in any clinical trial with an investigational drug or device within the past month or concurrent to study participation. Any current or past history of any physical condition which in the investigator's opinion might put the subject at risk or interfere with study results interpretation. History of positive screening urine test for drugs of abuse at screening: cocaine, amphetamines, barbiturates, opiates. Current (or chronic) use of opiates. History of epilepsy. History of rTMS exposure. History of any implanted device or psychosurgery for depression. History of ECT intolerance. History of shrapnel or metal in the head or skull. "Low Treatment Refractory" using the Maudsley staging method. History of cardiovascular disease or cardiac event. History of OCD. History of autism spectrum disorder. History of intractable migraine History of independent sleep disorder.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Nolan Williams, MD
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine
City
Stanford
State/Province
California
ZIP/Postal Code
94305
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
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SAINT for Treatment of Preoperative Depression to Reduce Opioid Use Following Arthroplasty

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